Autologous reliability with prosthetic precision—the latissimus dorsi flap (LDF) is back for a reason. In this episode we break down how to optimize LD flap breast reconstruction using “volume-added” harvest and smart expander/implant strategy.
We cover the operative setup from markings and skin paddle design to subfascial dissection to capture deep fat, high axillary tunneling, and inset strategies that improve contour while protecting the pedicle. We also clarify when to use expander as an intelligent spacer vs. immediate implant—and how Stage 2 refinement (4–6 months) improves final implant selection and symmetry.

Key Takeaways:

• Markings: center the skin island on the muscle; align to relaxed skin tension lines to reduce ugly scars.

• Volume-added harvest: stay just under thoracic fascia to bring deep fat for better mastectomy-edge camouflage.

• Preserve lateral contour: respect the upper anterior “zone of adherence;” tunnel high in the axilla.

• Protect perfusion: keep serratus branch intact—critical collateral if thoracodorsal is compromised.

• Seroma is the enemy: quilting/progressive tension sutures + drains can reduce chronic drainage.

Disclaimer: This content is for educational purposes only and is not medical advice.

#PlasticSurgery #BreastReconstruction #LatissimusDorsiFlap #Microsurgery #PRS #Residency

Links:🎧 Full episodes available now:

Instagram: https://www.instagram.com/plasticsinpractice/

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA

Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO

Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

References :

1. Hammond DC, Loffredo MA. Latissimus Dorsi Flap Breast Reconstruction. In: [Chapter 60]. (Source file provided).

2. Rios J, Adams WP, Pollock T. Progressive tension sutures to decrease latissimus donor site seroma. Plast Reconstr Surg. 2003;112:1779. (DOI/PMID not verified from provided source.)

Prosthetic breast reconstruction looks “simple” until you chase symmetry, fight the inframammary fold, and add radiation into the mix. This episode is a practical walkthrough of the two-stage expander–implant pathway—what actually matters, what fails, and how to plan it cleanly.

Episode overview
We cover patient selection, immediate vs delayed timing, modern biodimensional expanders, the expansion protocol, and the exchange operation with an emphasis on IMF positioning, inferior pole projection/ptosis, and strategies to optimize symmetry. We also break down ADM use (what it helps, what it costs), and why radiation changes complication risk and revision rates.

Key takeaways:

• Ideal implant candidates: thin, bilateral, or thin unilateral with a nonptotic contralateral breast.

• Expansion pearls: start ~10–14 days, fill 30–120 mL per visit; overexpand ~25–30% to build skin for ptosis/projection.

• ADM: enables larger initial fills and pocket control, but can increase seroma and infection-related failure.

• Exchange: measure base width/height/projection; IMF definition is the highest-leverage step.

• Radiation: higher capsular contracture/complication rates—plan sequencing and counsel hard.

Links
Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA
YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO
📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/
#PlasticSurgery #BreastReconstruction #Microsurgery #SurgicalEducation #Residency #TissueExpander #ImplantReconstruction #ADM #Oncoplastic #PRS

References:

1. Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions. Plast Reconstr Surg. 2010;125(6):1606-1614. PMID: 20517083.

2. Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2009;124(6):1772-1780. PMID: 19952633.

3. Cordeiro PG, Pusic AL, Disa JJ, et al. Irradiation after immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg. 2004;113(3):877-881. PMID: 15108879.

4. Preminger BA, McCarthy CM, Hu QY, Mehrara BJ, Disa JJ. Influence of AlloDerm on expander dynamics/complications in immediate TE/I reconstruction. Ann Plast Surg. 2008;60(5):510-513. PMID: 18434824.

   
   

   
   

   Disclaimer: This content is for educational purposes only and is not medical advice.

Breast cancer management isn’t “mastectomy vs lumpectomy.” It’s risk → imaging → tissue diagnosis → staging → locoregional control → systemic therapy, all tailored to tumor biology and patient goals.

In this episode, we walk through the modern evidence base that moved us from Halsted-era radical surgery to breast-conserving therapy + targeted systemic therapy, while keeping oncologic safety front and center.

Key takeaways:

• Screening: Average risk = annual mammography starting at 40; high-risk patients may add MRI starting ~30.

• Pathology framework: DCIS (basement membrane) vs LCIS (risk marker) vs invasive (ductal most common; lobular often occult on mammo).

• Breast conservation: Lumpectomy with negative margins + RT achieves survival comparable to mastectomy; RT dramatically improves local control.

• Axilla: SLNB is standard staging in early disease with lower morbidity; many patients avoid completion ALND depending on criteria + adjuvant RT.

• Systemic therapy: Endocrine therapy and targeted agents reduce recurrence risk—selection is tumor-marker driven.

Disclaimer: This content is for educational purposes only and is not medical advice.

#BreastCancer #BreastSurgery #PlasticSurgery #GeneralSurgery #Oncoplastic #SurgicalOncology #Residency #SLNB #DCIS #Mastectomy

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA
YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO
📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
Apple: https://podcasts.apple.com/us/podcast/plastics-in-prac
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

Citations (AMA):

1. Saslow D, Boetes C, Burke W, et al. CA Cancer J Clin. 2007;57(2):75-89. doi:10.3322/canjclin.57.2.75. PMID:17392385.

2. Fisher B, Redmond C, Poisson R, et al. N Engl J Med. 1989;320(13):822-828. PMID:2927449.

3. Clarke M, Collins R, Darby S, et al. Lancet. 2005;366(9503):2087-2106. doi:10.1016/S0140-6736(05)67887-7. PMID:16360786.

4. Giuliano AE, Hunt KK, Ballman KV, et al. JAMA. 2011;305(6):569-575. doi:10.1001/jama.2011.90. PMID:21304082.

5. Fisher B, Costantino J, Redmond C, et al. N Engl J Med. 1993;328(22):1581-1586. doi:10.1056/NEJM199306033282201. PMID:8292119.

6. Fisher B, Dignam J, Wolmark N, et al. Lancet. 1999;353(9169):1993-2000. doi:10.1016/S0140-6736(99)05036-9. PMID:10376613.

Gynecomastia isn’t “just fat.” It’s a spectrum—ductal tissue, stroma, and fat—driven by hormonal shifts across life stages. In this episode, we walk through a clean clinical framework: etiology → pathology timeline → exam/workup → severity grading → surgical plan, with pearls that prevent the most common aesthetic failures.

We cover when you can stop the workup, how to interpret florid vs fibrous disease by duration, and how Simon grading dictates whether you’re doing lipo, excision, pull-through, or formal skin resection. Then we get practical: incision placement, contour strategy, compression, drains, and how to avoid the nightmare complications—hematoma, under-resection, and the classic subareolar “saucer” deformity.

Key takeaways

• Gynecomastia peaks in neonatal, adolescent, and >65 age groups—think T:E ratio shift.

• Pathology tracks duration: florid <4 mo, intermediate 4–12 mo, fibrous >1 yr.

• Simon grade guides skin management—2b often deserves time + compression before skin excision.

• Preserve a 1–1.5 cm subareolar cuff to prevent NAC adherence/depression.

• If lipo leaves a residual “bud,” add pull-through (don’t accept under-resection).

Citations (AMA)

1. Rohrich RJ, Ha RY, Kenkel JM, Adams Wand management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. 2003;111(2):909-923. doi:10.1097/01.PRS.0000042146.40379.25. PMID:12560721.

2. Hammond DC. Surgical correction of gynecomastia. Plast Reconstr Surg. 2009;124(1 Suppl):61e-68e. doi:10.1097/PRS.0b013e3181aa2dc7. PMID:19568140.

3. Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48-52. doi:10.1097/00006534-197301000-00009. PMID:4687568.

4. Hammond DC, Arnold JF, Simon AM, Capraro PA. Combined use of ultrasonic liposuction with the pull-through technique for the treatment of gynecomastia. Plast Reconstr Surg. 2003;112(3):891-895. doi:10.1097/01.PRS.0000072254.75067.F7. PMID:12960873.

Disclaimer: This content is for educational purposes only and is not medical advice.

#PlasticSurgery #Gynecomastia #PRS #SurgeryEducation #Residency #AestheticSurgery #Liposuction

🎧 Full episodes available now:

Instagram: https://www.instagram.com/plasticsinpractice/

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA

Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO

Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

Vertical reduction mammaplasty represents a fundamental shift in breast reduction philosophy. Instead of relying on skin tension to maintain shape, the vertical approach prioritizes internal parenchymal architecture to create durable projection, narrower bases, and reduced scarring.

In this episode of Plastics in Practice, we break down the core principles of Hall-Findlay’s vertical reduction mammaplasty, focusing on how breast shape is determined by tension-free pillar closure—not a “skin brassiere.” We review anatomical foundations, marking strategies, pedicle selection, and operative techniques that consistently produce superior aesthetic outcomes.

Key topics include:

• Why nipple position should be based on the upper breast border, not the suprasternal notch

• The rationale behind the “snowman” skin resection

• Medial vs superomedial pedicles and their impact on vascular reliability and sensation

• Management of postoperative puckering and expectations for skin adaptation

• Common pitfalls, including under-resection and premature revision

This episode is designed for plastic surgery residents and early attendings looking to understand why the vertical technique works—not just how to perform it.

• Final breast shape comes from parenchymal pillars, not skin tension

• Vertical techniques improve projection and base width compared to inverted-T

• Medial pedicles demonstrate the highest sensation recovery (~85%)

• Inferior puckering is expected and usually resolves without intervention

• Predetermined resection weights help avoid under-reduction

Disclaimer: This content is for educational purposes only and is not medical advice.

#PlasticSurgery #BreastReduction #VerticalMammaplasty #PRS #Residency #HallFindlay #SurgicalEducation

1. Hall-Findlay EJ. Vertical breast reduction. Plast Reconstr Surg. PMID: 12711950.

2. Hall-Findlay EJ. Pedicles in vertical breast reduction. Clin Plast Surg. PMID: 15576215.

Macromastia reduction is where reconstructive principles collide with aesthetic outcomes—and the inverted-T (Wise) pattern stays dominant because it’s predictable. In this episode, we walk through the anatomic “non-negotiables” for NAC perfusion + sensation, then translate that into practical pedicle selection (inferior, superomedial, central mound, and vertical bipedicle) for the real cases: large breasts, ptosis, and gigantomastia.

What you’ll learn:

• Triple-source vascular logic (medial perforators/internal mammary, lateral thoracic, intercostals) and why collateralization matters in big moves. 1

• NAC sensation: protecting the lateral cutaneous branch of the 4th intercostal nerve and how pedicle choice influences risk. 1

• When inverted-T is the safer “teaching pattern” (large volume + skin excess) vs when vertical strategies make sense. 1,2

• Inferior vs superomedial: complication profiles and what changes in large-volume reductions. 3

• Free nipple grafting: true indications, functional tradeoffs, and evolving alternatives (extended/elongated pedicles). 4,5

Disclaimer: This content is for educational purposes only and is not medical advice.

#PlasticSurgery #Residency #BreastReduction #ReductionMammaplasty #WisePattern #InvertedT #NippleAreolaComplex #AestheticSurgery

Citations (AMA) — in text shown as #
References (numbered):

1. Study Guide – Breast Reduction: The Inverted-T Technique and Pedicle Variations.

2. Serra MP, et al. Breast reduction with a superomedial pedicle and a vertical scar… PMID: 20179472.

3. Ogunleye AA, et al. Complications After Reduction Mammaplasty… PMID: 28328638.

4. Talwar AA, et al. Outcomes of Extended Pedicle Technique vs Free Nipple Graft… PMID: 36161307.

5. Bonomi F, et al. Is free nipple grafting necessary… PMID: 38183875.

Ptosis + volume loss is the classic “deflated upper pole in a stretched envelope” problem—and mastopexy-augmentation is where planning mistakes become revisions. This episode breaks down how to choose the right mastopexy pattern, when augmentation alone is enough, and the technical pitfalls that drive complications (especially scarring, malposition, and ischemic risk).

We’ll walk through ptosis classification (Regnault), a nipple elevation + desired volume algorithm, and the practical tradeoffs between circumareolar, vertical (circumvertical), and Wise-pattern approaches. You’ll also get a clean framework for deciding one-stage vs staged augmentation-mastopexy, plus what to watch for in secondary cases (prior pedicles, thinning tissues, capsular work, “snoopy” and “ball-in-sock” deformities).

Key takeaways (resident-focused):

• Match technique to required nipple elevation and volume goal—not scar preference.

• Minimize undermining to protect NAC + skin flap perfusion.

• Conservative skin markings in aug-mastopexy: implants change nipple-to-fold geometry.

• One-stage is reasonable in good candidates; high-risk patients should usually stage.

• Revision drivers are often scar-related, not the “pattern” itself.

Disclaimer: This content is for educational purposes only and is not medical advice.

#PlasticSurgery #Mastopexy #BreastAugmentation #AestheticSurgery #PRS #Residency

Citations (AMA):

1. Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg. 1976;3(2):193-203.

2. Rohrich RJ, Thornton JF, Jakubietz RG, Jakubietz MG, Grunert JG. The limited scar mastopexy. Plast Reconstr Surg. 2004;114(6):1622-1630.

3. Spear SL, Dayan JH, Clemens MW. Augmentation mastopexy. Clin Plast Surg. 2009;36(1):105-115.

4. Stevens WG, Freeman ME, Stoker DA, Quardt SM, Cohen R, Hirsch EM. One-stage mastopexy with augmentation: 321 patients. Plast Reconstr Surg. 2007;120(6):1674-1679.

5. Stevens WG, Stoker DA, Freeman ME, Quardt SM, Hirsch EM. Mastopexy revisited: 150 cases. Aesthet Surg J. 2007;27(2):150-154.

   
   

   🎧 Full episodes available now:

   Instagram: https://www.instagram.com/plasticsinpractice/

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   Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

   YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO

   Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

   📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ

Breast augmentation is one of the most performed aesthetic operations—and still one of the most revised. This episode is a practical, surgeon-to-surgeon breakdown of how to drive reoperations down by treating planning as the operation.

We walk through a tissue-based philosophy: objective measurements (not cup-size promises), pocket selection that matches coverage needs, and operative decisions that prevent predictable failures like malposition, rippling, and capsular contracture.

Key takeaways (resident-focused):

• Reoperation rate is the scoreboard—plan backwards from the revision causes.

• Use objective sizing frameworks (e.g., High Five™ / TEPID) to reduce size-exchange revisions.

• Dual-plane logic: coverage where you need it, expansion where you want it—without iatrogenic damage.

• Rippling prevention is coverage math (pinch thickness rules matter).

• Capsular contracture: think contamination + biofilm risk; incision choice and technique aren’t “small details.”

• BIA-ALCL: know the textured implant association and the classic delayed seroma presentation.

Disclaimer: This content is for educational purposes only and is not medical advice.

Hashtags: #PlasticSurgery #BreastAugmentation #AestheticSurgery #PlasticsResidency #CapsularContracture #DualPlane #BIAALCL

Citations (AMA; numbered; alphabetical bibliography):

1. Tebbetts JB, Adams WP Jr. Five critical decisions in breast augmentation using five measurements in 5 minutes: the High Five decision support process. Plast Reconstr Surg. 2005;116(7):2005-2016. PMID: 16327616.

2. Tebbetts JB. A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg. 2002. PMID: 11964998.

3. Pajkos A, et al. Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg. 2003. PMID: 12655204.

4. Li S, et al. Capsular contracture rate after breast augmentation with periareolar versus other incisions: a meta-analysis. Aesthetic Plast Surg. 2018. PMID: 28916908.

5. Sharma B, et al. Breast implant–associated anaplastic large cell lymphoma. Lancet Oncol. 2020. PMID: 32302264.

   
   

   6. U.S. Food & Drug Administration. FDA requests Allergan recall of BIOCELL textured breast implants (2019).

• 
  

  🎧 Full episodes available now:

  Instagram: https://www.instagram.com/plasticsinpractice/

  Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA

  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216

  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO

  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/

  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ